DOCSLIB.ORG

Management of Itch in Atopic Dermatitis Judith Hong, MD,* Joerg Buddenkotte, Phd,*,† Timothy G

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Management of Itch in Atopic Dermatitis Judith Hong, MD,* Joerg Buddenkotte, Phd,*,† Timothy G Management of Itch in Atopic Dermatitis Judith Hong, MD,* Joerg Buddenkotte, PhD,*,† Timothy G. Berger, MD,* and Martin Steinhoff, MD, PhD‡ Atopic dermatitis is a common, pruritic, inflammatory skin disorder. Chronic, localized, or even generalized pruritus is the diagnostic hallmark of atopic dermatitis, and its manage- ment remains a challenge for physicians. The threshold for itch and alloknesis is markedly reduced in these patients, and infections can promote exacerbation and thereby increase the itch. Modern management consists of anti-inflammatory, occasionally antiseptic, as well as antipruritic therapies to address the epidermal barrier as well as immunomodulation or infection. Mild forms of atopic dermatitis may be controlled with topical therapies, but moderate-to-severe forms often require a combination of systemic treatments consisting of antipruritic and immunosuppressive drugs, phototherapy, and topical compounds. In addi- tion, patient education and a therapeutic regimen to help the patient cope with the itch and eczema are important adjuvant strategies for optimized long-term management. This review highlights various topical, systemic, and complementary and alternative therapies, as well as provide a therapeutic ladder for optimized long-term control of itch in atopic dermatitis. Semin Cutan Med Surg 30:71-86 © 2011 Elsevier Inc. All rights reserved. ruritus or itch, which is defined as an unpleasant sensa- and focus in-depth on the various types of treatments for Ption that elicits an urge to scratch,1 is such an integral part short-term and long-term management of itch in AD. of atopic dermatitis (AD) that it is a major characteristic in the diagnostic criteria and a hallmark of AD.2 AD has been called the “itch that rashes,”3 which reflects how important it is to Pathophysiology of Itch in AD pay attention to pruritus in the management of AD. Pruritus The sensation of pruritus can be triggered by endogenous can lead patients to scratch until they are bleeding, and and exogenous stimuli, which activate specific peripheral un- scratching in turn can aggravate the skin disease. Nocturnal myelinated C-fiber nerve endings in the epidermis and der- scratching is a common issue that can result in sleep distur- mis. The pruritogenic stimulus is then signaled along the bances and a dramatic impairment in the quality of life in dorsal root ganglion (which harbors the RNA and generates these patients. In addition, psychological disturbances, such the proteins expressed by or released from the cell surface of as stigmatization and social isolation,4 are also detriments to nerve-endings) via the spinal cord before it crosses the con- quality of life.5 In this article we briefly summarize current tralateral spinothalamic tract, reaching different areas of the knowledge of the pathophysiology and trigger factors of AD cortex. In the cortex, the scratching reflex is initialized in the motor-cortex and associated motor-cortex. Other cortical and subcortical regions can modulate the itch response, lead- *Department of Dermatology, University of California San Francisco, San Francisco, CA. ing to “sensitized skin” and itch-associated mood changes, 6,7 †Department of Surgery, University of California San Francisco, San Fran- for example. Thus, the central nervous system modulates cisco, CA. the perception of “itch” and triggers the desire to scratch. ‡Department of Dermatology, University Hospital, Münster, Münster, Ger- Various mediators of pruritus in AD interact with the pruri- many. toception pathway at different levels. For example, in lamina Dr. Judith Hong, Dr. Joerg Buddenkotte and Dr. Timothy G. Berger have nothing to disclose. Dr. Steinhoff has performed consultancy services for 1 of the dorsal horn, the gastrin-releasing peptide receptor 8,9 which he received compensation for Galderma, Merck, Sanofi-Aventis plays a role in mediating itch sensation in the spinal cord. and Regeneron. On behalf of Dr. Steinhoff, his institution has received The receptor for substance P (SP), the neurokinin-1 receptor, financial gifts from Maruho (Japan), and research was supported by is also highly expressed by lamina 1 neurons, which appears ZymoGenetics, L’Oreal and Galderma. to be crucial for the transmission of itch to the brain.6 Cuta- Address reprint requests to Martin Steinhoff, MD, PhD, Departments of 10 11-13 Dermatology and Surgery, University of California San Francisco, 513 neous inductors of itch include histamine, proteases, 14,15 Parnassus Avenue, Room S-1268, San Francisco, CA, 94143. E-mail: neuropeptides (eg, SP), acetylcholine (in atopic pa- [email protected] tients),16 cytokines,17 neurotrophin-4,18 platelet-activating 1085-5629/11/$-see front matter © 2011 Elsevier Inc. All rights reserved. 71 doi:10.1016/j.sder.2011.05.002 72 J. Hong et al Table 1 Therapeutic Ladder for AD Associated Pruritus For Consideration but Second Line (or First Line Controversial and/or Treatment Category First Line in Severe Disease) Minimal Evidence Trigger elimination ● Avoiding exogenous ● Food allergen avoidance in ● Bacterial decolonization triggers (see Table 2) symptomatic patients ● Food allergen avoidance ● Antimicrobials for overt in asymptomatic secondary infection patients ● Stress management ● Dust-mite reduction Topical therapy ● Emollients ● Calcineurin inhibitors* ● Menthol ● Corticosteroids ● Coal tar ● Capsaicin ● Naltrexone ● Doxepin Systemic therapy ● Oral sedating antihistamines ● Other (minimal evidence in AD, but immunosuppressants soporific effect may be (eg, azathioprine, helpful) mycophenolate mofetil, ● Combination of nonsedating methotrexate, interferon- and sedating antihistamines gamma) (high-dose) ● Mu-opiate receptor ● Cyclosporine A antagonists ● Corticosteroids ● Kappa-opioid agonist ● Neurogenic agents (eg, gabapentin, mirtazapine, paroxetine) Other ● Education about disease ● Phototherapy (UVA, UVA1, ● Excimer laser and treatment modalities UVB, Combination, PUVA) ● Herbals and botanicals Written instructions and/or ● Goeckerman (phototherapy ؉ ● Hypnotherapy ● handouts in addition to tar) ● Massage verbal instructions ● Psychological interventions ● Biofeedback (eg, cognitive-behavioral ● Acupuncture therapy, habit reversal therapy, autogenic training) AD, atopic dermatitis. *May be also used as first line for maintenance therapy. factor,19 endothelin, and certain leukotrienes.20 Of note, pruritus on patient’s lives, dermatologists need to recognize changes in the plasticity and receptor density, as well as neu- and address various aspects of itch, including: (1) identifica- ronal sensitization, may also be involved in AD pruritus.21 tion and elimination of trigger factors; (2) maintaining the The skin lesions in AD often have increased density of pe- skin barrier through emollients and occasional additives; ripheral nerve fibers, including substance P-positive nerve (3) targeting inflammation through topical medications, fibers.22 In addition, noxious stimuli, such as bradykinin in systemic medications, or phototherapy; (4) symptomatic the lesional skin of AD patients, have been demonstrated to management of itch with other treatments that are not provoke itch instead of pain, suggesting complex but poorly antiinflammatory; (5) addressing psychological and be- understood interactions between itch and pain fibers.23-25 havioral components; and (6) educating the patient (Table TH2-derived cytokines may be involved in crosstalk between 1). The use of multidisciplinary clinics or centers will be nerves and T lymphocytes, indicating a role of cytokines in discussed in further detail because they provide a setting itch and neuronal regulation.6,26,27 For an in-depth study, we where all these issues can be addressed. It is important for refer to other recent reviews focusing on the pathophysiology clinicians to “treat the patient, not just the disease” through of itch in AD.28-30 an approach that integrates medication, education, and sup- port. Overview: Treatment Options in AD Identification and Elimination of Trigger Factors Because itch is such a prominent and distressing aspect of AD, proper treatment of AD should involve the evaluation Identifying and eliminating trigger factors are crucial for the and management of any associated pruritus. Because of the management of itch in AD. Sweating is generally considered complex pathophysiology of pruritus in AD and the impact of one of the most common trigger of itch in AD,31 and in- Pruritus therapy in atopic dermatitis 73 creased sweating has been observed in AD patients with li- Table 2 Trigger Factors in AD for Consideration in the Long- chenified skin.32 Acetylcholine and vasoactive intestinal pep- Term Management of AD tide may play a role because both regulate sweat gland Allergies House dust mites, food allergens, air-born function and have been found to be increased in the skin of contact dermatitis (pollen, etc), animals, AD patients.33 The main methods to manage this frequent jewelry. trigger factor are avoidance of activities that lead to pro- Infections Staphylococcus aureus, viral infections nounced sweating or immediate washing and cooling after (herpes, molluscum), yeasts (eg, exercising. Anticholinergic drugs do not appear to have an Trichophyton, malassezia). impact on pruritus and can be avoided,34 supporting the idea Exogenous Soaps, solvents, wool, sweat, chemicals, toxins, cigarette smog, certain that neuropeptides, such as vasoactive intestinal peptide and ingredients of cosmetics probably yet unknown mediators, are more important in trig- Physical
Load more

Recommended publications
  • Genital Lichen Simplex Chronicus (Eczema, Neurodermatitis, Dermatitis) !
    Libby Edwards, MD Genital Lichen Simplex Chronicus (eczema, neurodermatitis, dermatitis) ! Lichen simplex chronicus (LSC), or eczema, is a common skin condition that is very itchy. Although not dangerous in any way, both the itching, and the pain from rubbing and scratching, can be miserable. Eczema/LSC of the genital area most often affects the scrotum of men, the vulva of women, or the rectal skin of both. Many people with eczema/LSC have had sensitive skin or eczema/LSC on other areas of the skin at some point, and many have a tendency towards allergies, especially hay fever or asthma. ! The skin usually appears red or dark, and thick from rubbing and scratching, sometimes with sores from scratching. ! The cause of eczema/LSC is not entirely clear. However, eczema/LSC starts with irritation that triggers itching. Often, at the office visit with the health care provider, the original infection or other initial cause of irritation is no longer present. Common triggers include a yeast or fungus infection, an irritating medication, moisturizer or lubricant, a wet bathing suit, anxiety or depression, over-washing, panty liners, sweat, heat, urine, a contraceptive jelly, an irritating condom, or any other activity or substance that can irritate the skin and start the itching. ! Although rubbing and scratching often feel good at first, rubbing irritates the skin and ultimately makes itching even worse, so that there is more scratching, then more itching, then more scratching. This is called the “itch-scratch cycle.” Treatment is very effective and requires clearing any infection and avoiding irritants as well as using a strong cortisone.
    [Show full text]
  • Lichen Simplex Chronicus
    LICHEN SIMPLEX CHRONICUS http://www.aocd.org Lichen simplex chronicus is a localized form of lichenified (thickened, inflamed) atopic dermatitis or eczema that occurs in well defined plaques. It is the result of ongoing, chronic rubbing and scratching of the skin in localized areas. It is generally seen in patients greater than 20 years of age and is more frequent in women. Emotional stress can play a part in the course of this skin disease. There is mainly one symptom: itching. The rubbing and scratching that occurs in response to the itch can become automatic and even unconscious making it very difficult to treat. It can be magnified by seeming innocuous stimuli such as putting on clothes, or clothes rubbing the skin which makes the skin warmer resulting in increased itch sensation. The lesions themselves are generally very well defined areas of thickened, erythematous, raised area of skin. Frequently they are linear, oval or round in shape. Sites of predilection include the back of the neck, ankles, lower legs, upper thighs, forearms and the genital areas. They can be single lesions or multiple. This can be a very difficult condition to treat much less resolve. It is of utmost importance that the scratching and rubbing of the skin must stop. Treatment is usually initiated with topical corticosteroids for larger areas and intralesional steroids might also be considered for small lesion(s). If the patient simply cannot keep from rubbing the area an occlusive dressing might be considered to keep the skin protected from probing fingers. Since this is not a histamine driven itch phenomena oral antihistamines are generally of little use in these cases.
    [Show full text]
  • The Dyshidrotic Eczema Area and Severity Index – a Score Developed for the Assessment of Dyshidrotic Eczema
    Clinical and Laboratory Investigations Dermatology 1999;198:265–269 Received: September 29, 1998 Accepted: February 19, 1999 The Dyshidrotic Eczema Area and Severity Index – A Score Developed for the Assessment of Dyshidrotic Eczema E. Vocks a S.G. Plötz b J. Ring a aDepartment of Dermatology and Allergology Biederstein, Technical University München, and bResearch Center Borstel, Center for Medicine and Bioscience, Borstel, Germany Key Words factors, such as atopic eczema, contact allergy or mycosis, Severity index • Dyshidrotic eczema • Pompholyx • but many cases are also classified as idiopathic [1–3]. As it Treatment study can be very resistant to treatment [4], studies with regard to new therapeutic modalities in dyshidrotic eczema are important. The evaluation of therapeutic effects is carried Abstract out by different methods. In most studies global assessment Background: Dyshidrotic eczema of the palms and soles methods like grading of improvement [5–8] are used. Hand is a common condition, which can be rather resistant to eczema scoring systems which are applied to eczema on the treatment. Therapy studies and their comparability are of palmar and dorsal hands are not specific for the distinct fea- clinical importance. Objective: As standardized assess- tures of dyshidrotic eczema [9]. Since the assessment meth- ment methods for the severity of this particular form of ods for dyshidrotic eczema are not standardized, therapeutic eczema are lacking, we developed a severity index for studies are not comparable and data cannot be utilized for dyshidrotic eczema. Methods: The Dyshidrotic Eczema epidemiologic purposes. As there is no specific scoring sys- Area and Severity Index (DASI) is based on the severity tem existing, we developed a severity index for dyshidrotic grade of single items – number of vesicles per square eczema on the occasion of a half-side treatment study with centimetre (V), erythema (E), desquamation (S) and itch tap water iontophoresis [10].
    [Show full text]
  • Skin Signs of Rheumatic Disease Gideon P
    Skin Signs of Rheumatic Disease Gideon P. Smith MD PhD MPH Vice Chair for Clinical Affairs Director of Rheumatology-Dermatology Program Director of Connective Tissue Diseases Fellowship Associate Director of Clinical Trials Department of Dermatology Massachusetts General Hospital Harvard University www.mghcme.org Disclosures “Neither I nor my spouse/partner has a relevant financial relationship with a commercial interest to disclose.” www.mghcme.org CONNECTIVE TISSUE DISEASES CLINIC •Schnitzlers •Interstitial •Chondrosarcoma •Eosinophilic Fasciitis Granulomatous induced •Silicone granulomas Dermatitis with Dermatomyositis Arthritis •AML arthritis with •Scleroderma granulomatous papules •Cutaneous Crohn’s •Lyme arthritis with with arthritis •Follicular mucinosis in papular mucinosis JRA post-infliximab •Acral Anetoderma •Celiac Lupus •Calcinosis, small and •Granulomatous exophytic •TNF-alpha induced Mastitis sarcoid •NSF, Morphea •IgG4 Disease •Multicentric Reticul •EED, PAN, DLE ohistiocytosis www.mghcme.org • Primary skin disease recalcitrant to therapy Common consults • Hair loss • Nail dystrophy • Photosensitivity • Cosmetic concerns – post- inflammatory pigmentation, scarring, volume loss, premature photo-aging • Erythromelalgia • Dry Eyes • Dry Mouth • Oral Ulcerations • Burning Mouth Syndrome • Urticaria • Itch • Raynaud’s • Digital Ulceration • Calcinosis cutis www.mghcme.org Todays Agenda Clinical Presentations Rashes (Cutaneous Lupus vs Dermatomyositis vs ?) Hard Skin (Scleroderma vs Other sclerosing disorders) www.mghcme.org
    [Show full text]
  • Swimmer's Itch Fact Sheet
    Fact Sheet for the general public Swimmer’s Itch (Cercarial Dermatitis) What is swimmer's itch? Swimmer's itch, also called cercarial dermatitis (sir-CARE-ee-uhl der-muh-TIGHT-iss), appears as a skin rash caused by an allergic reaction to certain parasites that infect some birds and mammals. These microscopic parasites are released from infected snails into fresh and salt water (such as lakes, ponds, and oceans). While the parasite’s preferred host is the specific bird or mammal, if the parasite comes into contact with a swimmer, it burrows into the skin causing an allergic reaction and rash. Swimmer’s itch is found throughout the world and is more frequent during summer months. How does water become infested with the parasite? The adult parasite lives in the blood of infected animals such as ducks, geese, gulls, swans, and certain aquatic mammals such as muskrats and beavers. The parasites produce eggs that are passed in the feces of infected birds or mammals. If the eggs land in or are washed into water, the eggs hatch, releasing small, free-swimming larvae. These larvae swim in the water in search of a certain species of aquatic snail. If the larvae find one of these snails, they infect the snail, multiply and undergo further development. Infected snails release a different type of larvae (or cercariae, hence the name cercarial dermatitis) into the water. This larval form then swims about searching for a suitable host (bird, muskrat) to continue the life cycle. Although humans are not suitable hosts, the larvae burrow into the swimmer’s skin, and may cause an allergic reaction and rash.
    [Show full text]
  • Understanding Eczema / Atopic Dermatitis
    Understanding Atopic Dermatitis An educational health series from National Jewish Health If you would like further information about National Jewish Health, please write to: National Jewish Health 1400 Jackson Street Denver, Colorado 80206 or visit: njhealth.org Understanding Atopic Dermatitis An educational health series from National Jewish Health IN THIS ISSUE About Atopic Dermatitis 2 What Causes Atopic Dermatitis? 3 Do You Have Atopic Dermatitis? 3 Should You Go to an Expert? 4 What Are Your Goals? 4 Avoiding Things that Make Itching and Rash Worse 5 Treatment and Medication Therapy 9 Soak and Seal 9 What Medicines Will Help? 10 Action Plan for Atopic Dermatitis 13 What to Do When Symptoms Are Severe 14 Living with Atopic Dermatitis 15 Remember Your Goals 15 Glossary 16 Note: This information is provided to you as an educational service of National Jewish Health. It is not meant as a substitute for your own doctor. © Copyright 2018, National Jewish Health About Atopic Dermatitis Atopic dermatitis is a common chronic skin disease. It is also called atopic eczema. Atopic is a term used to describe allergic conditions such as asthma and hay fever. Both dermatitis and eczema mean inflammation of the skin. People with atopic dermatitis tend to have dry, itchy and easily irritated skin. They may have times when their skin is clear and other times when they have rash. INFANTS AND SMALL CHILDREN In infants and small children, the rash is often present on face, as well as skin around the knees and elbows. TEENAGERS AND ADULTS In teenagers and adults, the rash is often present in the creases of the wrists, elbows, knees or ankles, and on the face or neck.
    [Show full text]
  • How to Treat Dandruff
    HOW TO TREAT DANDRUFF Dandruff is a common scalp condition in which small pieces of dry skin flake off of the scalp. The most effective way to treat and control dandruff is to use dandruff shampoo and scalp treatments. Follow these tips from dermatologists to get the best results. Dandruff is a common scalp condition in which small pieces of dry skin flake off of the scalp. If you have dark hair or you’re wearing dark colors, you may notice the flakes in your hair or on your shoulders. Dandruff may also make your scalp itch. Many people believe that dandruff is caused by poor hygiene, but this is not true. Although infrequent shampooing can make dandruff more obvious, researchers are still studying the causes, which appear to be complex. The most effective way to treat and control dandruff is to use dandruff shampoo and scalp treatments. Follow these tips from dermatologists to get the best results: 1. Follow the instructions on the dandruff shampoo bottle. There are many different dandruff shampoos, and each contains different active ingredients for controlling symptoms. To get the best results, always follow the instructions on the bottle. For example, some dandruff shampoos require that you lather the shampoo into the hair and scalp and leave the shampoo in for about five minutes before rinsing. Others should not be left on the scalp. 2. If you are Caucasian or Asian, shampoo daily and use dandruff shampoo twice a week. If using one dandruff shampoo does not bring relief, try alternating between dandruff shampoos with different active ingredients.
    [Show full text]
  • Or Moisture-Associated Skin Damage, Due to Perspiration: Expert Consensus on Best Practice
    A Practical Approach to the Prevention and Management of Intertrigo, or Moisture-associated Skin Damage, due to Perspiration: Expert Consensus on Best Practice Consensus panel R. Gary Sibbald MD Professor, Medicine and Public Health University of Toronto Toronto, ON Judith Kelley RN, BSN, CWON Henry Ford Hospital – Main Campus Detroit, MI Karen Lou Kennedy-Evans RN, FNP, APRN-BC KL Kennedy LLC Tucson, AZ Chantal Labrecque RN, BSN, MSN CliniConseil Inc. Montreal, QC Nicola Waters RN, MSc, PhD(c) Assistant Professor, Nursing Mount Royal University A supplement of Calgary, AB The development of this consensus document has been supported by Coloplast. Editorial support was provided by Joanna Gorski of Prescriptum Health Care Communications Inc. This supplement is published by Wound Care Canada and is available at www.woundcarecanada.ca. All rights reserved. Contents may not be reproduced without written permission of the Canadian Association of Wound Care. © 2013. 2 Wound Care Canada – Supplement Volume 11, Number 2 · Fall 2013 Contents Introduction ................................................................... 4 Complications of Intertrigo ......................................11 Moisture-associated skin damage Secondary skin infection ...................................11 and intertrigo ................................................................. 4 Organisms in intertrigo ..............................11 Consensus Statements ................................................ 5 Specific types of infection .................................11
    [Show full text]
  • Lichen Simplex Chronicus (Lsc)
    Buffalo Medical Group, P.C. Robert E. Kalb, M.D. Phone: (716) 630-1102 Fax: (716) 633-6507 Department of Dermatology 325 Essjay Road Williamsville, New York 14221 LICHEN SIMPLEX CHRONICUS (LSC) Lichen simplex chronicus is a form of eczema in the skin. It produces red inflamed scaling and itching areas. The first part of the word lichen refers to the fact that the area is slightly raised. The second part of the word simplex means it is the simple form of the condition. The third word chronicus refers to the fact that the problem tends to be present for many months or in some cases years. The exact cause of lichen simplex is unknown. In many cases the problem, which caused the original skin condition, has long since gone away. The original condition, however, set up a pattern where the skin was itched and scratched. This caused more itching and more scratching. Eventually this creates an itch/scratch cycle, which allows the condition to persist. This is despite the fact that the original problem is gone. In many cases, nerves and stress contribute to this itch/scratch cycle. Patches of lichen simplex can be seen in any area of the body. Some of the more common areas are the neck, private area, and around the ankles. Some patients have only one spot on the skin. Some patients have a large number of areas. Lichen simplex is not a sign of an internal problem. It is not a sign of cancer or any contagious skin problem. Fortunately, lichen simplex can be controlled in most cases.
    [Show full text]
  • Exanthems and Drug Reactions
    Dermatology Exanthems and Morton Rawlin drug reactions ‘Well, Mr Jones, I think we should put you on this tablet to Background fix this problem. Now, the things you need to look out for Drug reactions are a common cause of rashes and can vary are any rashes…’ from brief, mildly annoying, self limiting rashes to severe conditions involving multiple organ systems. How often in general practice do you hear yourself Objective offering this advice? Why do almost all drugs list rash as This article outlines an approach to exanthems that a side effect? How do they occur and what can you do to may be related to drug reactions and details appropriate recognise and manage them? management. The skin is the largest organ of the body and, from a diagnostic Discussion viewpoint, we can see it change to various stimuli. Medications Rashes related to drug reactions are both nonallergic and allergic. Nonallergic rashes are usually predictable and are commonly used and are integral to the general practitioner’s may be avoidable. Allergic rashes include morbilliform armamentarium for treating most ills. However, it is also important erythema, urticaria and angioedema, erythema multiforme to note that increasing access to medications by consumers through and vasculitic rashes. The vast majority of cases are other health professionals (eg. naturopaths) and the self prescribed rapidly resolving and self limiting once the offending use of over-the-counter, complementary and alternative medicines agent is removed. Early recognition and supportive should be remembered in the history taking of a patient presenting measures are the keys to care in the majority of cases.
    [Show full text]
  • Seborrheic Dermatitis
    Seborrheic Dermatitis The word "eczema" has come to mean a great variety of inflammatory, scaly, itchy skin conditions. One person may have atopic dermatitis and another seborrheic dermatitis, but they both describe their conditions as "eczema". Seborrheic Dermatitis Seborrheic dermatitis is a relatively common skin condition that usually is easily recognized and differentiated from other eczematous conditions. Its characteristics are: • Reddened, somewhat swollen patches of skin; and, • Yellowish-brown scales and crusts on affected areas of the skin, frequently on the scalp (a common cause of dandruff), and around the nose and mouth. • Seborrheic dermatitis is common in infancy and can occur again after puberty and in adulthood. Its cause is unknown. Unlike acne, which also has increased sebum production, seborrheic dermatitis is not a disease of the hair follicles and attendant sebaceous glands. The following photos are characteristic examples of seborrheic dermatitis: In adults, seborrheic dermatitis can resemble psoriasis, especially on the scalp. In some patients with a genetic predisposition for psoriasis, seborrheic dermatitis may be a forerunner or trigger for psoriasis Seborrheic Dermatitis in Infants The typical form of seborrheic dermatitis in infancy is "cradle cap"—oily scales and crusts on hairy portions of the scalp that may extend to the face and neck. The groin and armpits may also be affected, resembling "diaper rash." The infant form of seborrheic dermatitis is usually self-limiting and disappears after a period of weeks to months. A dermatologist to relieve symptoms and to be sure that the condition is not atopic dermatitis—a condition requiring different management, should treat seborrheic dermatitis.
    [Show full text]
  • Interdry for Intertrigo
    pat hways InterDry for intertrigo Medtech innovation briefing Published: 10 September 2019 www.nice.org.uk/guidance/mib192 Summary • The technology described in this briefing is InterDry. It is used for treating intertrigo, a common inflammatory skin ashr that usually develops in skin folds, such as in the groin, under the breast or in the armpits. • The innovative aspects are that the technology is designed to target all 3 factors associated with intertrigo: moisture, bacteria or fungi and friction from skin-to-skin contact. • The intended place in therapy would be as an alternative to other treatment options used in managing intertrigo. This may include topical or systemic antimicrobial agents and corticosteroids, and absorptive materials such as gauze. • The main points from the evidence summarised in this briefing are from 1 prospective single- arm observational study, 2 case series and 2 case reports including a total of 28 adults with intertrigo or complications associated with skin folds. Evidence suggests that InterDry may help to reduce the symptoms of intertrigo, including itching or burning, loss of skin layers, secondary lesions, redness and odour. • Key uncertainties around the technology are that the available evidence is very limited in quantity and quality. Well-designed comparative studies would be helpful to determine the benefits vo er current management options. The care pathway for intertrigo in the UK is not well defined and standard care may vary. © NICE 2020. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- Page 1 of conditions#notice-of-rights). 12 InterDry for intertrigo (MIB192) • The cost of InterDry is £43.07 for the 25 cm × 91 cm pouch and £105.95 for the 25 cm × 366 cm roll (exclusive of VAT).
    [Show full text]